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On Purpose: A Renewed Direction for Full Engagement in Life and Health with Vic Strecher Part 1

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  • 1. On Purpose A NEW DIRECTION FOR HEALTHRELATED BEHAVIOR CHANGE Victor J. Strecher, PhD, MPH Professor, University of Michigan School of Public Health email: strecher@umich.edu twitter: Vic Strecher@dungbeetlepress
  • 2. High Tailored Testimonial Tailoring Variables Used In This Case: + Age + Gender + Ethnicity + Marital status + Smoking status of spouse + Child in home + Physically active + # of cigs smoked + Job status + Barrier + Social Support
  • 3. MORE RELEVANT MESSAGES Information/advice MORE ELABORATION AND MEMORY, LESS WORK Stories Episodic memories Decisionmaking MORE BEHAVIOR CHANGE
  • 4. Re s e a rch Real world strecher@umich.edu
  • 5. Change
  • 6. 30%
  • 7. ?
  • 8. OPERATIONS RESEARCH inform s ® Vol. 56, No. 6, November–December 2008, pp. 1335–1347 issn 0030-364X eissn 1526-5463 08 5606 1335 doi 10.1287/opre.1080.0588 © 2008 INFORMS OR FORUM Personal Decisions Are the Leading Cause of Death Ralph L. Keeney The Fuqua School of Business, Duke University, Durham, North Carolina 27708, keeney@duke.edu This paper analyzes the relationships between personal decisions and premature deaths in the United States. The analysis indicates that over one million of the 2.4 million deaths in 2000 can be attributed to personal decisions and could have been avoided if readily available alternative choices were made. Separate analyses indicate 46% of deaths due to heart disease and 66% of cancer deaths are attributable to personal decisions, about 55% of all deaths for ages 15–64 are attributable to personal decisions, and over 94% of the deaths attributable to personal decisions result in the death of the individual making the decisions. Relative to the current 45%, retrospective appraisal suggests that roughly 5% of deaths in 1900 and 20%–25% of deaths in 1950 could be attributed to personal decisions. These results suggest that more effort directed toward improving personal choices regarding life risks may be an effective and economical way to save lives. Subject classifications: risk; decision making; decision analysis: applications; health care; information systems: management; statistics: data analysis. Area of review: Special Issue on Operations Research in Health Care. OR Forum. History: Received July 2006; revisions received March 2007, September 2007, February 2008; accepted April 2008. Participate in the OR Forum discussion at http://orforum.blog.informs.org.
  • 9. 1336 Operations Research 56(6), pp. 1335–1347, © 2008 INFORM Figure 1. Influences of personal decisions on causes of death. Personal decisions concerning Smoking Actual causes of death Medical causes of death Smoking Diseases of the heart Malignant neoplasms (cancer) Diet Being overweight Cerebrovascular diseases (stroke) Chronic lower respiratory diseases Exercise Alcoholic diseases Diabetes Mellitus (diabetes) Influenza and pneumonia Drinking alcohol Accidents Unintended injuries Chronic liver disease and cirrhosis Doing drugs Unprotected sex Hypertension and hypertensive renal disease Take your own life Illicit drugs Diseases of the circulatory system AIDS Condom use Suicide Intentional self-harm (suicide) Assault (homicide) Criminality Note. An arrow means “influences.” Homicide Other
  • 10. What do you know? Are you an expert on boiling water? This water isn’t so hot. Now go away, I’m getting kind of sleepy...
  • 11. Why?
  • 12. We’re defensive
  • 13. We’re all defensive
  • 14. Ego breaks open - then you see who you really are!
  • 15. Death is very likely the single best invention of life. It is life’s change agent.
  • 16. “Do not act as if you were going to live ten thousand years. Death hangs over you. While you live, while it is in your power, be good.” Marcus Aurelius
  • 17. Another way?
  • 18. Good mother. Good spouse. In control. Attractive.
  • 19. Good mother. Good spouse. In control. Attractive.
  • 20. “These studies, in concert with previous research, suggest that values affirmation reduces defensiveness via selftranscendence...”
  • 21. 92 College Students Social exclusion Ego Threat No Ego Threat “you weren’t picked” “you were picked”... but “randomly chosen to work alone
  • 22. Selftranscendent values Selfenhancement values empathy support needs larger than self growth relationships power wealth independence attractiveness prestige Daily routine (no values) “Please taste-test these cookies” Selftranscendent values Selfenhancement values empathy support needs larger than self growth relationships power wealth independence attractiveness prestige Daily routine (no values)
  • 23. Ego threat by type of value affirmed on self-regulatory exertion (measured by # of cookies eaten) F for interaction = 5.45, p<.01 # of cookies eaten 8.2 4.9 2.8 Selftranscendent values Selfenhancement values Daily routine (no values) Ego Threat 4.8 4.3 4.0 Selftranscendent values Selfenhancement values Daily routine (no values) No Ego Threat
  • 24. Ego threat by type of value affirmed on self-regulatory exertion (measured by # of cookies eaten) F for interaction = 5.45, p<.01 # of cookies eaten 8.2 4.9 2.8 Selftranscendent values Selfenhancement values Daily routine (no values) Ego Threat 4.8 4.3 4.0 Selftranscendent values Selfenhancement values Daily routine (no values) No Ego Threat
  • 25. Ego threat by type of value affirmed on self-regulatory exertion (measured by # of cookies eaten) F for interaction = 5.45, p<.01 # of cookies eaten 8.2 4.9 2.8 Selftranscendent values Selfenhancement values Daily routine (no values) Ego Threat 4.8 4.3 4.0 Selftranscendent values Selfenhancement values Daily routine (no values) No Ego Threat
  • 26. ORIGINAL ARTICLE Effect of a Purpose in Life on Risk of Incident Alzheimer Disease and Mild Cognitive Impairment in Community-Dwelling Older Persons Patricia A. Boyle, PhD; Aron S. Buchman, MD; Lisa L. Barnes, PhD; David A. Bennett, MD Context: Emerging data suggest that psychological and Results: During up to 7 years of follow-up (mean, 4.0 experiential factors are associated with risk of Alzheimer disease (AD), but the association of purpose in life with incident AD is unknown. years), 155 of 951 persons (16.3%) developed AD. In a proportional hazards model adjusted for age, sex, and education, greater purpose in life was associated with a substantially reduced risk of AD (hazard ratio, 0.48; 95% confidence interval, 0.33-0.69; PϽ.001). Thus, a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was approximately 2.4 times more likely to remain free of AD than was a person with a low score (score=3.0, 10th percentile). This association did not vary along demographic lines and persisted after the addition of terms for depressive symptoms, neuroticism, social network size, and number of chronic medical conditions. In subsequent models, purpose in life also was associated with a reduced risk of MCI (hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P=.02) and a slower rate of cognitive decline (mean [SE] global cognition estimate, 0.03 [0.01], P Ͻ .01). Objective: To test the hypothesis that greater purpose in life is associated with a reduced risk of AD. Design: Prospective, longitudinal epidemiologic study of aging. Setting: Senior housing facilities and residences across the greater Chicago metropolitan area. Participants: More than 900 community-dwelling older persons without dementia from the Rush Memory and Aging Project.
  • 27. J Behav Med DOI 10.1007/s10865-012-9406-4 Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up Eric S. Kim • Jennifer K. Sun • Nansook Park Laura D. Kubzansky • Christopher Peterson • Received: June 6, 2011 / Accepted: February 7, 2012 Ó Springer Science+Business Media, LLC 2012 Abstract This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study—a nationally representative panel study of American adults over the age of 50—were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit Coronary heart disease is the leading cause of death among both men and women in the United States—responsible for one in every six deaths (Heron et al., 2009). It imposes immense physical, psychological, social, and financial burden on individuals, families, and society as a whole. Ongoing research efforts have focused on identifying the risk and protective factors that prevent coronary heart disease and promote heart health. Past research has mostly looked at the impact of negative psychological states or traits (e.g. depression, anxiety, and cynical hostility) on health outcomes such as myocardial infarction (Kubzansky & Kawachi, 2000; Rozanski et al.,
  • 28. Contents lists available at SciVerse ScienceDirect Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd Original research Association of HbA1c with emotion regulation, intolerance of uncertainty, and purpose in life in type 2 diabetes mellitus Norman H. Rasmussen a,c,∗ , Steven A. Smith b,e , Julie A. Maxson c , Matthew E. Bernard c , Stephen S. Cha d , David C. Agerter c , Nilay D. Shah e a Department of Psychiatry and Psychology, Division of Integrated Behavioral Healthcare, Mayo Clinic, Rochester, MN, USA b Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA c Department of Family Medicine, Mayo Clinic, Rochester, MN, USA d Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA e Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA a r t i c l e i n f o a b s t r a c t Article history: Background: The extant literature lacks breadth on psychological variables associated with Received 19 December 2012 health outcome for type 2 diabetes mellitus (T2DM). This investigation extends the scope of Received in revised form psychological information by reporting on previously unpublished factors. 28 March 2013 Objective: To investigate if intolerance of uncertainty, emotion regulation, or purpose in life Accepted 16 April 2013 differentiate T2DM adults with sustained high HbA1c (HH) vs. sustained acceptable HbA1c Available online xxx (AH).
  • 29. Contents lists available at SciVerse ScienceDirect Journal of Psychosomatic Research Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study' Eric S. Kim ⁎, Jennifer K. Sun, Nansook Park, Christopher Peterson Department of Psychology, University of Michigan, Ann Arbor, USA a r t i c l e i n f o Article history: Received 13 July 2012 Received in revised form 19 January 2013 Accepted 22 January 2013 Keywords: Stroke Purpose in life Meaning in life Healthy aging Positive psychology a b s t r a c t Objective: To determine whether purpose in life is associated with reduced stroke incidence among older adults after adjusting for relevant sociodemographic, behavioral, biological, and psychosocial factors. Methods: We used prospective data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. 6739 adults who were stroke-free at baseline were examined. A multiple imputation technique was used to account for missing data. Purpose in life was measured using a validated adaptation of Ryff and Keyes' Scales of Psychological Well-Being. After controlling for a comprehensive list of covariates, we assessed the odds of stroke incidence over a four-year period. We used psychological and covariate data collected in 2006, along with occurrences of stroke reported in 2008, 2010, and during exit interviews. Covariates included sociodemographic factors (age, gender, race/ethnicity, marital status, education level, total wealth, functional status), health behaviors (smoking, exercise, alcohol use), biological factors (hypertension, diabetes, systolic blood pressure, diastolic blood pressure, BMI, heart disease), negative psychological factors (depression, anxiety, cynical hostility, negative affect), and positive psychological factors (optimism, positive affect, and social participation). Results: Greater baseline purpose in life was associated with a reduced likelihood of stroke during the four-year follow-up. In a model that adjusted for age, gender, race/ethnicity, marital status, education level, total wealth, and functional status, each standard deviation increase in purpose was associated with a multivariate-adjusted odds ratio of 0.78 for stroke (95% CI, 0.67–0.91, p=.002). Purpose remained significantly associated with a reduced likelihood of stroke after adjusting for several additional covariates including: health behaviors, biological factors, and psychological factors. Conclusion: Among older American adults, greater purpose in life is linked with a lower risk of stroke. © 2013 Elsevier Inc. All rights reserved.
  • 30. 009). Meaning in life and mortality. Journal of Gerontology: Social Sciences, 64B(4), 517–527, doi:10.1093/geronb/gbp047. Advance Access publication on June 10, 2009. Meaning in Life and Mortality Neal Krause Department of Health Behavior and Health Education, School of Public Health and the Institute of Gerontology, University of Michigan, Ann Arbor. Objectives. The purpose of this exploratory study was to see if meaning in life is associated with mortality in old age. Methods. Interviews were conducted with a nationwide sample of older adults (N = 1,361). Data were collected on meaning in life, mortality, and select control measures. Results. Three main findings emerged from this study. First, the data suggest that older people with a strong sense of meaning in life are less likely to die over the study follow-up period than those who do not have a strong sense of meaning. Second, the findings indicate that the effect of meaning on mortality can be attributed to the potentially important indirect effect that operates through health. Third, further analysis revealed that one dimension of meaning—having a strong sense of purpose in life—has a stronger relationship with mortality than other facets of meaning. The main study findings were observed after the effects of attendance at religious services and emotional support were controlled statistically. Discussion. If the results from this study can be replicated, then interventions should be designed to help older people find a greater sense of purpose in life. Key Words: Meaning in life—Mortality.
  • 31. 009). Meaning in life and mortality. Journal of Gerontology: Social Sciences, 64B(4), 517–527, doi:10.1093/geronb/gbp047. Advance Access publication on June 10, 2009. Meaning in Life and Mortality Neal Krause Department of Health Behavior and Health Education, School of Public Health and the Institute of Gerontology, University of Michigan, Ann Arbor. Objectives. The purpose of this exploratory study was to see if meaning in life is associated with mortality in old age. Methods. Interviews were conducted with a nationwide sample of older adults (N = 1,361). Data were collected on meaning in life, mortality, and select control measures. Results. Three main findings emerged from this study. First, the data suggest that older people with a strong sense of meaning in life are less likely to die over the study follow-up period than those who do not have a strong sense of meaning. Second, the findings indicate that the effect of meaning on mortality can be attributed to the potentially important indirect effect that operates through health. Third, further analysis revealed that one dimension of meaning—having a strong sense of purpose in life—has a stronger relationship with mortality than other facets of meaning. The main study findings were observed after the effects of attendance at religious services and emotional support were controlled statistically. Discussion. If the results from this study can be replicated, then interventions should be designed to help older people find a greater sense of purpose in life. Key Words: Meaning in life—Mortality.
  • 32. Intensive meditation training, immune cell telomerase activity, and psychological mediators Tonya L. Jacobs a,*, Elissa S. Epel b, Jue Lin c, Elizabeth H. Blackburn c, Owen M. Wolkowitz b, David A. Bridwell d, Anthony P. Zanesco a, Stephen R. Aichele e, Baljinder K. Sahdra a, Katherine A. MacLean f, Brandon G. King a, Phillip R. Shaver e, Erika L. Rosenberg a, Emilio Ferrer e, B. Alan Wallace g, Clifford D. Saron a,h a UC Davis Center for Mind and Brain, Davis, CA, USA b UC San Francisco Department of Psychiatry, San Francisco, CA, USA c UC San Francisco Department of Biochemistry and Biophysics, San Francisco, CA, USA d UC Irvine Department of Cognitive Science, Irvine, CA, USA e UC Davis Department of Psychology, Davis, CA, USA f Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA g Santa Barbara Institute for Consciousness Studies, Santa Barbara, CA, USA h UC Davis Medical Center M.I.N.D. Institute, Sacramento, CA, USA PURPOS E Received 22 January 2010; received in revised form 28 August 2010; accepted 17 September 2010 KEYWORDS Meditation; Neuroticism; Perceived control; Purpose in life; Stress; TELOMERE Summary Background: Telomerase activity is a predictor of long-term cellular viability, which decreases with chronic psychological distress (Epel et al., 2004). Buddhist traditions claim that meditation decreases psychological distress and promotes well-being (e.g., Dalai Lama and Cutler, 2009). Therefore, we investigated the effects of a 3-month meditation retreat on telomerase activity and two major contributors to the experience of stress: Perceived Control (associated with
  • 33. Journal of Substance Abuse Treatment 40 (2011) 183 – 188 Regular article Purpose in life predicts treatment outcome among adult cocaine abusers in treatment Rosemarie A. Martin, (Ph.D.) a,⁎, Selene MacKinnon, (Psy.D.) a , Jennifer Johnson, (Ph.D.) b , Damaris J. Rohsenow, (Ph.D.) a,c a b Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA c Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI 02908, USA Received 15 June 2010; received in revised form 14 September 2010; accepted 6 October 2010 Abstract A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies but has not been studied as a predictor of cocaine treatment outcome. This study examined pretreatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p b .01) predicted relapse to any use of cocaine and to alcohol and the number of days cocaine or alcohol was used in the 6 months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine-dependent patients. © 2011 Elsevier Inc. All rights reserved. Keywords: Cocaine; Purpose in life